Two recurring characters are introduced in an episode that teaches the odd-couple plastic surgeons a few lessons about moral boundaries. Patti D'Arbanville plays Wallis Forsythe, a pornography mogul who meets Christian at a party and agrees to send some business his way. And Joey Slotnick plays Merrill Bobolit, a hack surgeon who's more successful than Sean and Christian because of his willingness to take on any client. Forsythe's easy money and Bobolit's sleazy competition inject a dose of conflict into Sean and Christian's partnership--as if it needed any more of it!

An ex-lover returns and leads Christian to a sexaholics meeting while Sean and Julia deal with an unexpected pregnancy.

Christian's difficulties with Kristin are exacerbated when his feelings for Julia are revealed. Jude is hired as an intern, to sexy and disastrous results. Matt is caught mid-threesome by Julia.

Sean and Jude's respective secrets are revealed, and Merril offers Christian an interesting trade: Kimber for a Lamborghini. Christian accepts, but Kimber discovers the truth and exacts a small revenge.

After Julia's accident in the previous episode, Julia turns to Sean and Christian to fix her face. Sean resists at first, but eventually decides to do it after Christian lies to him and says the woman that was going to fix her face botched several jobs. Sean tells Julia that he keeps trying to forgive her and wants to try to love her again, but that it wouldn't happen right away.

Julia has an adverse reaction to the anesthesia and dreams during her surgery. Ava shows up in her dream as a different form of life coach, and guides her through this surreal life. Julia is married to Christian, which seems happy on the outside, but is really falling apart on the inside. They run the Troy/Troy partnership firm. When Christian decides to leave the practice, Julia interviews another doctor - Sean, someone she knew from high school. Trying to catch up on old times, Sean invites Julia and Christian to dinner. They meet his wife, Megan O'Hara, and their son Matt, who is on the nerdy side and has a bug collection. Megan is three months pregnant with a girl they plan on calling Annie, named after his grandmother. Julia is upset after a visit to Liz, an OB/GYN in this world, who has two kids. Julia cannot have kids with Christian, who wanted to have a biological child since he was adopted. Kimber, Julia and Christian's three-way partner becomes pregnant, and Christian refuses to get rid of it. We are revisited by several characters, including Mrs. Grubman, Jude, and Julia's friend Suzanne.

When Julia wakes up in recovery, Sean is there waiting for her. She has realized that things would never work out with Christian, and that Sean was always the one she loved.

After Christian's Carver attack, Sean must look for a new partner to keep the practice going. Sean has to surgically separate an obese woman from a couch she has spent the past three years on. Julia realizes that she has to make a decision about the future of her marriage.